Boutonneuse fever in a child: a case report and overview

Area of Science:

• Pediatrics
• Infectious Diseases
• Dermatology

Background:

• Acute febrile illness in children can be challenging to diagnose, especially with non-specific symptoms like fever, abdominal pain, myalgia, arthralgia, and rash.
• Rickettsial infections are a group of zoonotic diseases that can present with a wide range of clinical manifestations.

Observation:

• A five-and-a-half-year-old boy presented with acute febrile illness, abdominal pain, generalized myalgia, arthralgia, and skin rash.
• Initial broad-spectrum antibiotics and extensive investigations for common febrile illnesses were inconclusive.
• A positive Weil-Felix test (OX-2 titre 1:100), history of dog contact, and a tick bite mark suggested a rickettsial etiology.

Findings:

• The patient showed a dramatic clinical improvement within five days of initiating antibiotic therapy.
• The child completed a two-week course of chloramphenicol and recovered fully.
• Weil-Felix test results, combined with epidemiological clues, were crucial in diagnosing rickettsial infection.

Implications:

• Rickettsial infections should be strongly considered in the differential diagnosis of acute febrile illnesses with rash in children, particularly after potential exposure to ticks or infected animals.
• Early and specific antimicrobial therapy can lead to rapid resolution of symptoms and prevent severe complications.
• This case underscores the importance of a thorough history, physical examination, and targeted investigations in managing febrile illnesses in pediatric patients.